For all DOI occurring on or after 01/01/2018: emergency treatment services and medical treatment rendered for a body part accepted as compensable by the ER and addressed by the medical treatment utilization schedule, by a member of the MPN or HCO or by predesignated physician, within 30 days following the DOI shall be authorized without prospective UR. Which entity is listed as acceptable to address the treatment?

• A. It must be addressed by a member of the MPN
• B. It must be addressed by a HCO
• C. It must be addressed by a predesignated physician
• D. It must be addressed by the medical treatment utilization schedule

Answer: (D)

The situation hinges on the Medical Treatment Utilization Schedule (MTUS) being the controlling reference for authorizing medical treatment. When a DOI is on or after January 1, 2018, emergency treatment and medical treatment for a compensable body part, if addressed by the MTUS, are allowed without prospective utilization review as long as the care is provided by a member of the MPN, a health care organization, or a predesignated physician and occurs within 30 days of the DOI. In this setup, the MTUS itself is the entity that addresses and governs whether the treatment is authorized.

So the correct choice points to the MTUS as the entity that addresses the treatment, not the provider type. While the other options describe who can deliver care (MPN member, HCO, or predesignated physician), the authorization framework relies on the MTUS addressing the treatment within the 30-day window.